Clarity Amidst the Smoke: Moyamoya Disease, a Diagnosis Not to Be Missed

Moyamoya disease (MMD) is a rare, progressive cerebrovascular disorder characterized by the bilateral stenosis of the internal carotid artery (ICA) and its proximal vessels, leading to the formation of compensatory smoke-like collateral vessels. This report describes the case of a 33-year-old Philippine woman who presented with acute right-sided hemiparesis and had a history of recurrent transient ischemic attacks (TIAs) with similar symptoms. Neuroimaging revealed intracranial hemorrhage and characteristic bilateral occlusion of the internal carotid artery (ICA), middle cerebral artery (MCA), and anterior cerebral artery (ACA) with collateral vessel formation, indicative of moyamoya disease. The patient was referred for surgical revascularization.